This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Thursday, 26 February 2009

The Daily Express: WTF planet do they live on?

Just came across an article by Victoria Fletcher of the Daily Express.I am so glad I don't take these "journalists" seriously. I really am. Ms. Fletcher is one of the better ones actually as far as "health" articles go. Sad isn't it.

Yes we know that patients are suffering horrifically. Nurse Anne and her loved ones also suffer a great deal when they are patients. Do they really think that patients are suffering because nurses and doctors don't understand these "commandments". Idiots. The NHS managers who think that dignity cards are going to improve things need to educated... or perhaps they need to be stopped from trying to pass the buck.

In some hospitals, investigations found that some patients too ill to feed themselves were ignored and then had the food taken away from them, causing them to become malnourished.

Last year an investigation into an outbreak of a hospital bug that claimed 90 lives in Maidstone and Tunbridge Wells NHS Trust revealed patients were told to soil their beds because staff would not take them to the toilet.

Last week it emerged that TV chatshow host Michael Parkinson, 73, will lead a new campaign to boost respect for elderly patients. He regularly visited his mother Freda in her last days in hospital before she died aged 95 last year.

He said: “I came across an extraordinary mixture of care – some nurses who were utterly dedicated and wonderful.

But there were others who treated it a bit like they were a jailer, treated people in their care as inmates. There were distressing signs of elderly people being left weeping who were still there half an hour later, and that’s not right.

“I used to worry about leaving her on her own.”

THE 10 DIGNITY RULES

1. Have a zero tolerance of all forms of abuse.

2. Support people with the same respect you would want for yourself or a member of your family.

3. Treat each person as an individual by offering a personalised service.

4. Enable people to maintain the maximum possible level of independence, choice and control.

5. Listen and support people to express their needs and wants.

6. Respect people's right to privacy.

7. Ensure people feel able to complain without fear of retribution.

8. Engage with family members anDd carers as care partners.

9. Assist people to maintain confidence and a positive self-esteem.

10. Act to alleviate people's loneliness and isolation.

Well duh.

Not only am I concerned about the sanity of our NHS managers but I am also seriously concerned about Victoria Fletcher's. I have seen a few articles by her that were so way off base it is sickening. This one is obviously slanted to have a go at frontline staff and it's enough to send me over the edge.

I thought journalists were supposed to do research and commit to getting their facts straight. Vicki seems to think the the patients' dignity is being compromised and that cold trays are food are being left out of reach because the nurses are thick and lazy. Not one quote from a ward nurse. Vicky, my dear, you need a reality check and you need to start doing research. It would help to talk to people who work on the wards rather than people who only have a narrow simplistic view.

"Staff would not take them to the toilets causing them to soil their beds". Did it ever ever occur to Vicky that these nurses are in a position so precarious that they cannot always just stop and constantly toilet people? The nurses do not want things to be this way. They don't have a choice. If they are caught fucking up meds/orders or not noticing changes in condition because they are constantly toileting they are going to end up in front of a judge.

All we are constantly told is to prioritize prioritize and prioritize. The IV medication to stop that seizure comes first before the bedbath. The blood transfusion must be done before the commode. The man who can't breath must be sorted before the pain meds can be given. But the thing is, the top priority stuff never goes away long enough for us to do any basic care. If I am doing basic care someone else is not getting their blood, pain meds, or their hypoglycemic attack noticed and sorted. They die. Things move that fast.

Can you imagine my saying "sorry doc I cannot squeeze/infuse that gelofusion into your shocky patient or do anything else for him right now because 10 people need the commode. See you in about an 2 hours because I need to wash the commodes when I am done and then others will want it, and then I will wash it again".

That would go over like a lead balloon.

Vicky, we need more goddamn help and less of your ignorant bullshit.

Vicky would sue my ass off if I was caring for her loved one dying of sepsis and I left him to take someone to the toilet. What about when I am running up and down the ward trying to round up the supplies etc to implement the doc's plan to save Vicky's septic loved one? Should I stop during the course of that everytime someone asks for the loo? That would keep me away from Vicky's loved one for hours. Does Vicky think that another nurse would magically appear to help me out? Does Vicky think that those situations just disappear so that I can run around toileting everyone.

No one wishes for that more than we do.

Does Vicky think that the managers care and the nurses don't? Jesus Christ. How misinformed can a person be? The nurses and doctors care more than anyone. The "bad" ones may have just been caught up in the middle of something that they cannot control. This is what causes patients to wait. I have never seen a nurse make someone wait intentionally.

If anyone would listen to the nurses we would tell you why people aren't being fed and nursed.

Do your research. Visitors, etc see that the situation is damn bad but they have no insight into what the nurses are struggling against. They cannot see past their own grief enough to understand the situation on the ward as a whole.

Anne, great to see that you have got your mojo back and have been posting some great posts recently - it really sucks what you and your colleagues have to put up with from your management. Your journalist is not alone - it appears that most of them never do any research.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.